tbuckley/cabot-search huggingface dataset:
Abstract P239: Impact of American Heart Association/American Stroke Association Online Support Network on Quality of Life
Authors: Remy Poudel, Lynne T Braun, Allison Groom, Katherine Bahn, William Akel, Kathleen L Grady
Journal: Circulation (2023)

Introduction: Support of patients with cardiovascular (CV) disease and stroke is often associated with improved health-related quality of life (HRQOL). Hypothesis: We assessed the hypothesis that change in patient HRQOL, perception of emotional and informational support, and satisfaction with the American Heart Association/American Stroke Association’s (AHA/ASA) online Support Network (SN) would be observed from before joining the SN to two months after joining the SN. Methods: Using a pre/post-test design, between April 2018 and March 2020, 2,542 adult patients completed a baseline online survey, of whom 412 completed a survey two months later (response rate=16%). Self-report instruments included: Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Questionnaire, Emotional Support (ES), Informational Support (IS), and an AHA/ASA-developed measure of satisfaction with the SN. After converting raw scores into T-scores, linear mixed effects models were used to compare pre and post T-scores. Results: Patients were on average 56± 12.8 years of age, female (63.3%), non-Hispanic White (76.5%), married (58.3%), employed (49.8%), and &gt;high school education (85.0%). 83.5% reported having a CV condition, most commonly hypertension (38.8%), myocardial infarction (31.3%), high cholesterol (31.1%), atrial fibrillation (25.2%); 58.0% reported ≤ 4 co-morbidities. T-scores (mean±SD) did not differ significantly from before to two months after joining the SN: physical health domain (pre=39.2±3.6, post=39.3±3.4) and mental health domain (pre=43.3±9.6, post=44.5±9.7); ES (pre=49.5±9.8, post=49.3±9.8), and IS (pre=49.8±10.3, post=50.5±10.5). At two months, satisfied, neutral, and dissatisfied with SN were 46.3%,44.2%, and 5.1% respectively. 61.5% were likely to recommend the SN to others. Conclusions: In conclusion, HRQOL measures remained stable. Before and after SN participation, physical and mental domain global health scores were lower than the U.S. general population mean of 50, while ES and IS scores approximated the U.S. general population mean. Satisfaction with the SN was moderate with the majority of respondents likely to recommend to others. Future research might explore extending the timeframe to observe change in global health scores.
Abstract P600: Beyond Mean Glucose: Development of Novel, Reproducible Continuous Glucose Monitoring Metrics
Authors: Joseph Sartini, Michael Fang, Mary R Rooney, Rashmi (Nisha) Aurora, Naresh Punjabi, Elizabeth Selvin, Josef Coresh, Scott Zeger
Journal: Circulation (2023)

Introduction: Continuous glucose monitoring (CGM) devices record blood glucose every few minutes over a maximum 2-week wear period. Despite the richness of these data, existing first and second moment statistics (such as mean glucose) fail to capture the “shape” of variation in the CGM time-series. Objective: We developed novel, reproducible CGM shape metrics using functionals of the periodogram, a decomposition of CGM signal ( Figure 1A ) variance, to comprehensively characterize glucose patterns. Methods: We analyzed CGM data from N = 160 HYPNOS clinical trial participants with type 2 diabetes who wore CGM sensors twice, 3 months apart. We first calculated log-transformed periodograms for each person-period. To these decompositions, we fit piece-wise linear models over 3 frequency ranges: less than 1/24 hrs -1 (long term patterns), 1/24 to 2/5 hrs -1 (daily diet patterns), and greater than 2/5 hrs -1 (immediate fluctuations due to food). Slopes of fit segments, value at first frequency, and values at segment midpoints were extracted as our initial metrics ( Figure 1B ). We estimated and compared the within-person test-retest correlation for our shape measures against existing CGM and glucose metrics: mean glucose, time-in-range, and HhbA1c. Results: The highest raw correlation among the new shape metrics (r = 0.737) was comparable to that of the existing metrics (r = 0.798) ( Figure 1C ). Even after adjusting the shape metrics for existing metrics, there was a maximum test-retest correlation of r = 0.778. The shape metrics also carried information distinct from existing metrics. According to mixed effect models fit to data from both wear periods, the shape metrics explain less than 16% of variance in any existing metric when controlled for the other existing metrics. Conclusion: These new shape metrics carry reproducible information distinct from that of standard CGM metrics and HbA1c. The next step is to evaluate whether these novel shape metrics, which leverage the granularity of CGM data, can be linked to clinical endpoints.
Abstract P596: Familiar Hypercholesterolemia is Associated With Lower All-Cause Mortality Despite Higher Complexity of Coronary Lesions and Interventions Among Patients Admitted With Acute Myocardial Infarction
Authors: Dennis D Kumi, Ufuk Vardar, Sadichhya Karki, Edwin Gwira-Tamattey, Ayesha Abbasi
Journal: Circulation (2023)

Background: Familiar hypercholesterolemia is a genetic disorder affecting lipoprotein metabolism which is strongly associated with early atherosclerosis. Our resolve in this study is to evaluate the severity of coronary lesions ,complexity of acute interventions and clinical outcomes. Hypothesis: Patients with familiar hypercholesterolemia are relatively younger, have high coronary atheroma burden with less comorbidities, thus likely to have complex atherosclerosis but with paradoxical better prognosis. Method: A retrospective cohort study with data from the 2016 to 2018 combined National Inpatient Sample (NIS) database was employed. ICD-10 codes were used to sample all admissions for acute myocardial infarction who were then dichotomized based secondary diagnosis of familiar hypercholesterolemia. Procedure codes of ICD-10 were used to identify patients undergoing coronary revascularizations. We determined relative frequencies of various ischemic injury patterns and complexity of revascularization procedures among the two cohorts. Primary clinical outcome of mortality rate, and secondary outcomes including length of stay and total hospital charge were then assessed. Multivariate linear and logistic regressions were used to adjust for confounders. Results: We identified a total of 4,300,389 adult hospitalizations for acute myocardial infarction including 0.033% with familiar hypercholesterolemia. Patients with familiar hypercholesterolemia were younger (55.8 years vs 58.2 years, adjusted mean difference: -7.87 years, 95%CI: -9.49 years to -6.0 years). Table 1 below shows details of outcomes of our study. Conclusion: Among patients hospitalized with acute myocardial infarction, comorbid familiar hypercholesterolemia was associated with a 62% reduction in odds of in-hospital all-cause mortality despite a 2.25-fold increased odds of STEMI and higher odds for having multivessel percutaneous. revascularization.
Abstract MP72: Intrinsic Motivation is Associated With Greater Physical Activity and Less Sedentary Behavior During Early Pregnancy
Authors: Susan D Brown, Michaela Kiernan, Samantha F Ehrlich, Monique Hedderson, Saher Daredia, Andrea Millman, Matthew P Buman, Hillary Serrato Bandera, Charles P Quesenberry, Assiamira Ferrara
Journal: Circulation (2023)

Background: National guidelines recommend physical activity (PA) during pregnancy for optimal cardiovascular and overall health. Yet most individuals do not engage in sufficient PA and motivation for PA during pregnancy is poorly understood. Methods: We examined intrinsic motivation for PA (i.e., engaging in activity for enjoyment or satisfaction) and its cross-sectional associations with PA, by intensity level, in the first trimester of pregnancy. Data come from the Pregnancy, Lifestyle and Environment Study (PETALS), a population-based cohort study set in an integrated health system. Following recruitment at 10-13 weeks’ gestation, participants ( N =472; 71% from racial/ethnic groups other than White) completed the validated Behavioral Regulation in Exercise Questionnaire-2 (BREQ-2, intrinsic subscale); and Pregnancy Physical Activity Questionnaire (PPAQ) to estimate typical PA in the prior 2 months, as expressed in MET [metabolic equivalent] hours/week (by intensity and, for MVPA, by domain—i.e., limited to intentional activity such as sports, walking, aerobic exercise, etc.). Data were collected in 2017-18. Results: As hypothesized, intrinsic motivation was higher among those who met ( n =192, 40.7%) vs. did not meet national guidelines for 150 minutes/week of moderate-to-vigorous intensity PA (MVPA; mean BREQ-2 scores [SD]: 2.84 [0.89] vs. 1.94 [1.02], p &lt;0.0001). Likewise, intrinsic motivation was higher among those who scored at or above ( n =131, 27.8%) vs. below the sample-specific 75 th percentile for vigorous PA (2.86 [0.93] vs. 2.09 [1.03], p &lt;0.0001); and lower among those who scored at or above ( n =119, 25.2%) vs. below the 75 th percentile for sedentary behavior (1.99 [1.14] vs. 2.41 [1.01], p =0.0005). Intrinsic motivation was not associated with reaching the 75 th percentiles for total, light, or moderate PA. In modified Poisson regression models adjusted for age, pre-pregnancy body mass index, race/ethnicity, education, and parity, a 1-unit increase in BREQ-2 score was associated with an increased probability of meeting or exceeding MVPA guidelines (rate ratio [95% CI]: 1.66 [1.48, 1.86]) and scoring at or above the 75 th percentile for vigorous PA (1.70 [1.44, 1.99]). A 1-unit increase in BREQ-2 score decreased the probability of scoring at or above the 75 th percentile for sedentary behavior (0.79 [0.67, 0.92]). Conclusions: Only 4 in 10 participants met national guidelines for MVPA in the first trimester of pregnancy. Intrinsic motivation was associated with greater MVPA and vigorous PA, and less sedentary behavior, in this diverse sample. Intrinsic motivation is potentially modifiable and thus a promising target for new behavioral interventions to improve maternal cardiovascular health.
Abstract P538: Abnormal Serum Potassium is Associated With Risk of Chronic Kidney Disease Progression and All-Cause Mortality in Patients With Chronic Kidney Disease
Authors: Samantha O'Connell, Andrei R Stefanescu, Jenilee Cueto, Hua He, Jing Chen, Morgan Grams, Amanda H Anderson, Jiang He, Katherine T Mills
Journal: Circulation (2023)

Introduction: Chronic Kidney Disease (CKD) is a major risk factor for end-stage renal disease (ESRD) and premature death. It remains unclear if abnormal serum potassium is associated with CKD progression. We assessed the prospective relationship between serum potassium with both CKD progression and all-cause mortality among participants with CKD in the Chronic Renal Insufficiency Cohort (CRIC) Study. Methods: The CRIC study is a prospective cohort study of 3,939 participants with CKD from seven locations in the United States. Serum potassium was calculated as the cumulative mean from serum samples collected at baseline and annual follow-up visits prior to developing an event. Clinical cut points were used to group serum potassium: hypokalemia (&lt;3.5 mmol/L), normokalemia (≥3.5 and ≤5.0 mmol/L), and hyperkalemia (&gt;5.0 mmol/L). Kidney disease progression was defined as either incident end-stage renal disease or a 50% decline in estimated glomerular filtration rate (eGFR) from baseline. Cox proportional hazards models were used to examine the associations between serum potassium and CKD progression and all-cause mortality adjusting for baseline age, sex, race/ethnicity, education, clinic site, body mass index, cigarette smoking, alcohol drinking, physical activity, history of diabetes, hypercholesterolemia, and cardiovascular disease, use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, use of diuretics, use of other antihypertensive medications, and eGFR. Results: CRIC patients had a mean age of 57.7 years, were 45.1% female, and 41.9% Non-Hispanic Black. The prevalence of hypokalemia and hyperkalemia was 2.5% and 7.3%, respectively. Over an average 6.5 and 11.0 years of follow-up for CKD progression and all-cause mortality, respectively, 1,784 CKD progression events and 1,621 deaths occurred. Hypokalemia had a hazard ratio (HR) of 1.65 [95% confidence interval (CI): 1.25-2.10; p=.0004] for CKD progression compared with normokalemia. Similarly, hyperkalemia had a HR of 1.76 (95% CI, 1.50-2.06, p&lt;.0001) for CKD progression compared to normokalemia. The HR for all-cause mortality were 1.57 (95% CI, 1.13-2.18; p=.0066) for hypokalemia compared with normokalemia, and 1.43 (95% CI, 1.19-1.72, p=.0001) for hyperkalemia compared with normokalemia, after multivariable adjustment. Conclusions: Our study found that abnormally high and low serum potassium is associated with increased risk of CKD progression and all-cause mortality. These findings suggest that interventions that maintain serum potassium levels in the normal range may reduce the risk of CKD progression and premature death among patients with CKD.
Abstract MP74: Trends in Cardiovascular Health Counseling Among Postpartum Individuals in the United States From 2016-2020: The Pregnancy Risk Assessment Monitoring System
Authors: Natalie A Cameron, Lynn M Yee, Brigid M Dolan, Matthew J O'Brien, Philip Greenland, Sadiya S Khan
Journal: Circulation (2023)

Introduction: Poor pre-pregnancy cardiovascular health (CVH) and adverse pregnancy outcomes (APOs) are risk factors (RF) for lifetime risk of cardiovascular disease. Contemporary rates and trends of CVH counseling can inform strategies to optimize postpartum CVH. Methods: We used data from 2016-2020 from the Pregnancy Risk Assessment Monitoring System (PRAMS), a national, population-based survey of postpartum individuals. The primary outcome was self-report of counseling received on “healthy eating, exercise, and losing weight gained during pregnancy,” at the 4-6 week postpartum visit. We calculated the age-standardized weighted percent of individuals reporting CVH counseling for each year, overall, and by RF strata: (1) any pre-pregnancy CVH factor (obesity, diabetes, or hypertension) and (2) any APO (gestational diabetes, hypertensive disorders of pregnancy, or preterm birth). We quantified annual average percent change (APC) from 2016-2020. Lastly, we pooled data from 2016-2020 and determined odds ratios (OR) of counseling comparing individuals with and without RFs, adjusted for age, education, postpartum insurance, and year of delivery. Results: Among 206,080 individuals (weighted N = 10,630,861), 89.8% (95% confidence interval 89.6-90.1%) attended a postpartum visit. In 2016, 57.6% (56.7%-58.5%) reported CVH counseling. From 2016-2020, counseling was similar or experienced small declines overall (APC -1.1%/year [-1.3, -0.8]), for any pre-pregnancy CVH factor (-0.2%/year [-1.1, 0.7]) and any APO (-1.5%/year [-2.2, -0.8]). Counseling was modestly higher among those with any pre-pregnancy CVH factor (OR 1.2 [1.2, 1.3]) or any APO (OR 1.1 [1.1, 1.2]) compared with individuals without RF (TABLE). Conclusions: Of the 9 of 10 individuals who attended a postpartum visit, only about half reported CVH counseling, even among those with poor pre-pregnancy CVH or APOs without improvement in the past 5 years. Multilevel efforts should prioritize the postpartum period as an opportunity for CVH promotion.
Abstract MP30: Metabolomics Analyses Identified Factors Modifying the Association of Aspirin Use With Kidney Function
Authors: Ruiyuan Zhang, Xiao Sun, Zhijie Huang, Varun Rao, Yang Pan, Xi Cao, Yizhuo Liu, Shengxu Li, Lydia A Bazzano, Wei Chen, Jiang He, Tanika N Kelly, Changwei Li
Journal: Circulation (2023)

Introduction: Uncontrolled high dose aspirin use impairs kidney function. Short-term low dose aspirin treatment has also been associated with kidney function in older patients. We aimed to evaluate the association of regular aspirin use with kidney function in middle-aged adults and to identify factors modifying the association. Methods: We performed cross-sectional analyses among 1,261 participants of the 2016 Bogalusa Heart Study (BHS) visit. Regular aspirin use was self-reported and confirmed by serum biomarker, salicyluric glucuronide . Aspirin users were categorized at the median of salicyluric glucuronide levels into low and high dose users. A total of 887 known metabolites were profiled from the serum. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi equation. We tested associations of aspirin use with eGFR and examined interactions of aspirin with serum metabolites on eGFR. Age, sex, race, education, smoking, drinking, physical activity, BMI, blood pressure, and fasting glucose were adjusted in all analyses. Results: The mean age of BHS participants was 48.2, and 133 (10.5%) were self-reported aspirin users. Serum salicyluric glucuronide level was significantly correlated with self-reported aspirin usage (P=2.00х10 -21 ). After adjusting for all covariables, mean eGFR for never, low dose, and high dose aspirin users were 92.9, 90.2, and 89.9 mL/min/1.73m 2 , respectively (P for trend=0.004). After Bonferroni correction, 28 metabolites modified the associations of aspirin use with eGFR (P&lt;5.52х10 -5 ), of which, 26 increased the aspirin's nephrotoxicity effect, while behenoylsphingomyelin and tricosanoylsphingomyelin significantly attenuated the eGFR lowering effect of aspirin (Table). Conclusion: Aspirin use is associated with decreased eGFR among middle-aged adults, and this association was modified by dietary, gut microbiome, and biomarkers of kidney disease, cardiovascular disease, and cancer. The findings may help develop better use strategies for regular users.
Abstract P222: Consuming a Vegan Diet Compared to Omnivore Diet Leads to No Significant Changes in Serum TMAO, Fasting Glucose, Insulin, or Vitamin B12: The Twins Nutrition Study (TwiNS) Randomized Controlled Trial
Authors: Catherine P Ward, Matthew J Landry, Christopher D Gardner
Journal: Circulation (2023)

Introduction: Vegan diets are often encouraged for a myriad of health reasons, traditionally for control of blood lipid, cholesterol, and lipoprotein values. We proposed looking at other markers of health, including serum trimethylamine N-oxide (TMAO), fasting glucose, fasting insulin, or vitamin B12 in identical twins assigned to either a vegan or omnivore diet. Hypothesis: We hypothesized that the healthy vegan diet would lead to lower TMAO, fasting glucose, and fasting insulin (better), and lower vitamin B12 (worse) than the healthy omnivore diet. Methods: Identical twins were recruited and randomized to a healthy vegan or healthy omnivore diet. All twins consumed an omnivorous diet before enrollment. Meals were provided via a meal delivery service from baseline through week 4, with participants supplementing the delivered meals with their own diet adherent snacks. For delivered meals, both the healthy vegan and healthy omnivore diets were designed to consist of whole grains, legumes, and produce, with the main difference being omnivore diets provided ~1/3 of energy intake from animal-sourced foods. Participants prepared their own meals and snacks from weeks 5-8. Participants received nutrition education at baseline via orientation and were encouraged to choose “healthy” snacks, which for those on the vegan diet included legumes, nuts, seeds, and produce, and for those on the omnivore diet included dairy, nuts, seeds and produce. To assess compliance and intake, 24-hour dietary recalls were taken at weeks 0, 4, and 8. Clinical labs were collected at baseline, week 4, and week 8 through Stanford Medicine and analyzed both onsite and at Washington University St. Louis. Results: No significant differences between baseline and 4 or 8 weeks were seen in serum TMAO, fasting glucose, fasting insulin, or vitamin B12 between vegan and omnivorous twins (n=44). Conclusions: Vegan diets are often encouraged for their health promoting benefits; however, a healthy omnivorous diet can lead to comparable clinical lab outcomes. Funding: This study was supported by a generous donor, by the National Heart, Lung, and Blood Institute (NIH 5T32HL007034), and the Stanford Clinical and Translational Science Award (NIH UL1TR001085).
Abstract P306: Life’s Essential 8 is Associated With All-Cause and Cardiovascular Disease Mortality Among Community Dwelling Older Men and Women in the InCHIANTI Study of Aging (1998-2020)
Authors: Vivek Sarma, Yichen Jin, Stefania Bandinelli, Luigi Ferrucci, Toshiko Tanaka, Sameera Talegawkar
Journal: Circulation (2023)

Introduction: The population of individuals aged 65 y and older has increased steeply over the past few years. Health factors including obesity, high cholesterol, blood pressure, and blood glucose levels, as well as adverse health behaviors such as smoking, poor diet, insufficient physical activity, and low sleep quality are risk factors for chronic disease development and mortality. Because both health factors and behaviors are critical for reducing the risk of chronic disease and mortality, we examined a score assessing overall cardiovascular health (CVH) based on American Heart Association’s (AHA) Life’s Essential 8, an update of the AHA’s former Life’s Simple 7 metric. This metric may provide a tenable framework for chronic disease management and prevention. Hypothesis: We hypothesized that in a cohort of participants aged 65 y and older, higher CVH scores based on Life’s Essential 8, indicating better CVH, at baseline, is inversely associated with risk of all-cause and CVD mortality. Methods: Overall cardiovascular health was assessed using 8 health factors and behaviors, scored 0 to 100, among 928 participants (55% female) aged 65 years and older within the InCHIANTI study of aging. Vitality status was ascertained using registry information. For analysis, CVH was modeled as a 1 Standard Deviation (SD) increase in the score. Cox proportional hazards models, adjusted for age and sex, were used to examine the associations between CVH and all-cause and cardiovascular disease mortality over a median follow-up of 14.6 y. Results: A 1 SD increase in the overall CVH score was inversely associated with all-cause (hazard ratio [HR] = 0.80, 95% confidence interval [CI] = [0.738, 0.873]) and CVD mortality (HR = 0.73, 95% CI = [0.632, 0.832]). Conclusion: Among older adults, overall CVH - assessed through the lens of the AHA's Life's Essential 8 - is associated with a lower risk of all-cause and CVD mortality. This relationship lends credence to the importance of prioritizing health factors and behaviors in preventing chronic disease development and promoting healthier lives among older individuals.